Americana Health and Rehabilitation

Inspectors wroteBased on interviews and record review, the facility failed to initiate bowel interventions for 5 of 8 residents (Resident 17, 24, 27, 2 & 6) reviewed for quality of care. This failure placed residents at risk for discomfort, experiencing health complications and a diminished quality of life.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure intravenous (IV) access devices were assessed, maintained and monitored in accordance with professional standards of practice for 2 of 2 residents (Residents 1 & 46) reviewed for IV therapy. This failure placed residents at risk for unidentified complications including loss of vascular access, infection, and other potential negative health outcomes.

Inspectors wroteBased on interview and record review, the facility failed to ensure resident funds were conveyed (the act of legally transferring property from one entity to another) to the Office of Financial Recovery (OFR) within 30 days of death or discharge for 1 of 2 discharged residents (Resident 62) reviewed for trust accounts. This failure resulted in a delayed final accounting and conveyance of Resident 62's funds.

Inspectors wroteBased on observation, interview and record review, the facility failed to obtain a Safety Device Evaluation and Consent and/or physician's order for 1 of 1 sampled residents (Resident 43) reviewed for physical restraints. This failure placed the residents at risk of injury, unmet needs, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure admission Minimum Data Sets (MDS, an assessment tool) were completed within 14 days of admission as required, for 1 of 18 sample residents (Resident 2) reviewed for comprehensive assessments. This failure placed residents at risk for unidentified and/or unmet care needs.

Inspectors wroteBased on interview and record review, the facility failed to ensure assessments accurately reflected residents' health status and care needs for 2 of 18 sample residents (Residents 6 & 2) reviewed. This failure placed residents at risk for unidentified and/ unmet care needs and decreased quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure resident care plans were reviewed, revised, and accurately reflected residents' care needs for 3 of 18 residents (Residents 1, 2 & 46) whose care plans were reviewed. These failures placed residents at risk for unidentified/ unmet care needs and a diminished quality of life.

Inspectors wroteBased on interview, and record review, the facility failed to ensure services provided met professional standards of practice for 3 of 18 residents (Residents 1, 2 & 46). Failure of nursing staff to follow and/or clarify physicians' orders when indicated, and to notify the physician of weight variances and when medications were held, placed residents at risk delayed changes in medication regimen, hypotension, falls and other adverse outcomes.

Inspectors wroteBased on interview and record review, the facility failed to ensure 1 of 2 residents (Resident 2) reviewed for limited Range of Motion (ROM) received treatment and services to maintain and/or improve ROM. The failure to ensure residents were offered/provided Restorative Nursing Programs (RNPs) at the frequency they were assessed to require, placed residents at risk for decline in ROM, contracture formation, reduction in strength and mobility, increased dependence on staff and decreased quality of life.

Inspectors wroteBased on observation, record review and interview, the facility failed to ensure food items were labeled and dated when opened in 1 of 2 kitchen refrigerators, and in 1 of 1 nourishment refrigerators/freezers reviewed for proper food storage. This failure placed residents at risk for cross-contamination, food borne illness, and a diminished quality of life.

Inspectors wroteBased on observation and interview, the facility failed to label medications with the date first accessed in 2 of 3 medication storage areas (Ocean Side medication storage room and Ocean Side medication cart) reviewed for medication storage and labeling, and the facility failed to ensure medications were kept secure when observed on a bedside table for 1 of 1 sampled residents (6) reviewed for medication storage. These failures placed residents at risk of receiving compromised/ineffective medications, medication errors and diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure residents and/or resident representatives were informed and provided consent before administering an influenza vaccination for 1 of 5 sampled residents (24) reviewed for right to be informed to make treatment decisions. This failure placed residents and/or resident representatives at risk of not being fully informed of the risks and benefits before making decisions about vaccinations and a diminished quality of life.

Inspectors wroteBased on observation, interview and record review, the facility failed to ensure residents were free from physical restraints for 1 of 2 sampled residents (19) reviewed for physical restraints. This failure placed residents at risk for injury and a decreased quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to develop a comprehensive care plan for anticoagulant side effect monitoring (a high-risk, blood thinning medication) for 1 of 5 sampled residents (150) reviewed for comprehensive care plans. This failure placed residents at risk for complications, unmet care needs and a diminished quality of life.

Inspectors wroteBased on interviews and record reviews, the facility failed to ensure bowel interventions were initiated for 1 of 6 sampled residents (35) reviewed for quality of care related to constipation. This failure placed residents at risk for discomfort, health complications and a diminished quality of life.

Inspectors wroteBased on observation, interview, and record review, the facility failed to implement Enhanced Barrier Precautions (EBP) during wound care for 1 of 2 sampled residents (33) reviewed for infection prevention and control. This failure placed residents at risk for contracting infectious diseases and a decreased quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure the physician was consulted regarding a signification change in respiratory status and failed to notify the physician of the need for oxygen administration orders related to oxygen levels and obtain timely a needed seasonal allergy and asthma medication for 1 of 4 sampled residents (Resident 1) reviewed for notification of changes including a significant change in resident health status. Resident 1 experienced harm when hospitalization and intubation was required for respiratory failure related to untreated respiratory symptoms. This failure placed residents at risk for medical complications and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure bathing opportunities were provided for dependent residents for 1 of 2 sampled residents (145) reviewed for activities of daily living (ADLs). This failure placed residents at risk of skin infections, decreased dignity, and a diminished quality of life.

Inspectors wroteBased on interview and record review, the facility failed to ensure performance reviews were completed for 1 of 2 sampled nursing assistants (NA) (Staff E) reviewed for performance reviews. This failure placed residents at risk for receiving care from unskilled staff.

Inspectors wroteBased on interview and record review, the facility failed to ensure nursing hours were accurately posted daily for 12 of 30 days reviewed for nurse staff posting. This failure placed residents, resident representatives, and visitors at risk of not being fully informed of the current staffing levels and census.